Provider Demographics
NPI:1255067898
Name:EDWARDS, EUGENE
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 446
Mailing Address - Street 2:
Mailing Address - City:NEBO
Mailing Address - State:NC
Mailing Address - Zip Code:28761-0004
Mailing Address - Country:US
Mailing Address - Phone:828-925-1696
Mailing Address - Fax:
Practice Address - Street 1:152 E FOREST DR
Practice Address - Street 2:
Practice Address - City:NEBO
Practice Address - State:NC
Practice Address - Zip Code:28761-9540
Practice Address - Country:US
Practice Address - Phone:828-925-1696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-26
Last Update Date:2023-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5017459363LA2100X
M0956578146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC250554OtherNURSE
M0956578OtherNATIONAL REGISTRY